Background and objectives: Nosocomial infections/Hospitalacquired infections (HAI) constitute an important problem worldwide accounting for high morbidity and mortality as well as longer hospital cost and stay. An intensive care unit (ICU) is often the epicenter of infection, due to its extremely vulnerable population. Consequently, ICUs have highest occurrence rates of nosocomial infections causing an enormous impact on health and often survival. This study was therefore aimed to know the prevalence and antibiotic susceptibility profile of various organisms causing HAI in ICUs of a Tertiary Care Hospital and Medical College.
Materials and methods: A total of 847 consecutive samples mostly respiratory secretions, blood, and urine were collected from patients admitted in 6 ICUs of a tertiary care hospital and medical college from January 2017 to December 2017 and processed as per Clinical and Laboratory Standards Institute (CLSI) guidelines in the Microbiology department. Final identification and antimicrobial susceptibility testing of isolates were done by the automated Vitek 2 system.
Results: Among the 847 samples processed 513 (60.5%) were positive for growth. Gram-negative organisms 366/513 (71.34%) were more commonly isolated than 147/513 (28.65%) Gram-positive organisms. Multidrug-resistant (MDR), Klebsiellapneumoniae, Acinetobacterbaumannii complex and Pseudomonasaeruginosa along with Extended-spectrum betalactamases (ESBL) producing Escherichia coli among Gramnegative organisms and methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) among Gram-positive were the most conspicuous findings.
Conclusion: Our results showed higher resistance among all microorganisms in the ICUs compared to the rest of the hospital, the fact that highlights that ICUs should act as a critical point in the control of nosocomial infections.
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Devgun P, Gill K, Nagpal M, Mahajan SL, Kaur A. A Study of Knowledge of Anganwadi Workers about Common Mental Health Problems in Beneficiaries of the Integrated Child Development Services Scheme in Amritsar, Punjab, India. Curr Trends Diagn Treat 2018; 2 (1):4-8.
Introduction: Integrated child development services (ICDS) scheme has a focus on the physical health of the beneficiaries, though ideally, all the dimensions of health, be it physical, mental, social, emotional, spiritual should be equally addressed. Mental health problems abound, and their timely diagnosis and treatment can drastically cut down the morbidity associated with them. Anganwadi workers (AWWs) can prove to be an asset in this timely diagnosis. However, not much is known about the adequacy of knowledge and level of training of AWWs to recognize the commonly prevalent mental health problems in their wards. Materials and methods: The present study was a crosssectional study conducted from April to June 2014 on 1405 AWWs working in district Amritsar to know about their comprehension of mental health problems. A semi-structured pre-tested performance was used for the purpose. The data so collected were analyzed using SPSS (version 21.0) software. Percentages and chi-squared values were calculated. Results: Majority of the AWWs, i.e, 605 (43.0%) were in the age group of 30 to 39 years, 1124 (80.0%) were educated to matriculation, and above, 723(51.5%) had been serving for 10-20 years. More than half 823 (58.6%) were conversant with mental health problems. Depression was the most commonly cited mental health problem 1342 (95.5%) followed by mental retardation 1293 (92.0%) and antisocial behavior 1185 (84.3%). Conclusion: A strong association between cognition of mental health problems and literacy status of the AWWs (χ2 = 137.48, p < 0.05), duration of service (χ2 = 28.18, p < 0.05) and participation in in-service training for the up-gradation of their knowledge (χ2 = 47.15, p < 0.05) was found.
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Sharma S, Kaur J. Evaluation of Triple Biomarker Algorithm for Identification of Bacterial Sepsis in Critical Care Patients of a Tertiary Care Hospital. Curr Trends Diagn Treat 2018; 2 (1):9-14.
Introduction: Early and accurate identification of bacterial infection is crucial for the improved clinical outcome of a patient with sepsis, a diagnostic challenge in the intensive care unit (ICU). Virtually, all patients in the ICU have some inflammatory response associated with the fever which does not at all require antibiotics, thus differentiating between sepsis and non-infectious systemic inflammatory response syndrome (SIRS) is imperative. A study was therefore done to evaluate triple biomarker algorithm for identification of bacterial sepsis in critical care patients.
Materials and methods: One hundred and ninety-seven immunocompetent adult patients with presumed bacterial sepsis admitted in various ICUs of Sri Guru Ram Das University of Medical Sciences and Research were consecutively enrolled from November 2016 to October 2017. Blood samples obtained from these were subjected to culture and sensitivity as per clinical and laboratory standards institute (CLSI) guidelines in Department of Microbiology after approval by the ethical committee. Serial concentrations of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) of 39 patients who fulfilled the inclusion criteria were determined at baseline, 24 hours, 48 hours and 72 hours in the Department of Biochemistry. The performance characteristic of various biomarkers individually and in combination was studied.
Results: Of the total 2831 adult indoor febrile patients, ICU admissions were 197/2831(6.9%) of which only 58/197(29.44%) were culture positive, yielding bacteria and Candida species in 52/58 (89.65%) and 6/58 (10.34%) respectively. There were significant (p < 0.05) difference in the levels of PCT and IL-6 among the bacteremic group.
Conclusion: Procalcitonin (PCT) and IL-6 are superior to CRP in the early identification of bacterial infection. However, more perspective and large-scale studies are warranted to confirm these findings.
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Gupta S, Grover R, Bhargawa A. Assessment of Occlusal Characteristics in Primary Dentition of Preschool Children in Amritsar, Punjab, India. Curr Trends Diagn Treat 2018; 2 (1):15-21.
Background: The occlusal relationship and spacing in deciduous dentition are known to have an imperative demeanor on the setting up of the normal occlusal relationship in permanent dentition. The attribute set of features of this dentition acts as a mirror for the prevalence of malocclusion in the permanent dentition. The properly placed teeth in the dental arch not only uphold the health of the oral cavity and the supporting structures but also sway the persona of the children.
Aims and objectives: The objective of this study is to assess the characteristic features of occlusion in primary dentition (spacing, molar, and canine relation) among the urban and rural preschool children of Amritsar.
Materials and methods: Preschool children 3–5 years of age having the complete set of deciduous teeth were included in the study. Informed consent for the child\'s participation was taken from their parents and school principal. The dentition was examined under natural daylight, and the data was recorded. All the school children were screened for spaced and non-spaced dentition, molar, and canine relationship according to Foster and Hamilton criteria (1969). The data will be compared and analyzed.
Results: Straight terminal plane 60.5%, distal step 3.3%, mesial step 36.3%. Class 1, 2, and 3 canine relationships were 78%, 4%, and 18%, unilateral and bilateral posterior crossbite were 3.3% and 0%,Primate spacing was found in 75.3% of the population. Overjet >3 mm was registered in 3.8%, openbite in 2.0%, and overbite >3 mm in 6.8% of the preschool children.
Conclusion: Flush terminal plane, class I canine relation, ideal overjet, ideal overbite, and spaced arches prevailed among the majority of the study population without any gender variations or variations in the urban and rural areas of Amritsar city.
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Kaur M, Kaur K. A Study to Assess the Knowledge of Staff Nurses Regarding DOTS Therapy in View of the Preparation of Informational Booklet at Tertiary Care Hospital, Amritsar, Punjab, India. Curr Trends Diagn Treat 2018; 2 (1):22-27.
Background: Tuberculosis remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago and highly effective drugs and vaccines are available making tuberculosis a preventable and curable disease. Under the Revised National Tuberculosis Control Programme (RNTCP), directly observed short course treatment (DOTS) is a comprehensive strategy for tuberculosis control and has proven effective in controlling tuberculosis on a mass basis.
Material and methods: This study was conducted on 200 staff nurses working at tertiary care hospital during morning and evening shifts. A quantitative approach was used with research design as nonexperimental with the descriptive survey. Sampling Technique was Convenient sampling. Data was collected using directly observed short therapy course (DOTS) therapy knowledge questionnaire which was prepared by the principal author from an extensive review of the literature and validated from the experts of nursing, community medicine, and pulmonary medicine physicians.
Statistical analysis: The result showed that 64% of staff nurses were having knowledge below average, 29.5% falls in average group, and only 6.5% were having good knowledge regarding DOTS. On further analysis, Socio-demographic variables were found to be non-significant with the level of knowledge of staff nurses.
Conclusion: It was concluded that overall knowledge score among staff nurses was relatively deficient in spite of widespread dissemination of information, keeping in view the analyzed data and considering the knowledge deficiency, an Informational booklet regarding the information on DOTS therapy was developed by the principal author which was further extensively reviewed by the experts of nursing and medical college and then distributed among all the staff nurses.
Baljit S Khurana
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Lalit M, Mahajan A, Chaudhary R, Khurana BS. Identification of Common Morphological Lip Patterns in North Indian Population and their Role in Forensic Investigations. Curr Trends Diagn Treat 2018; 2 (1):28-31.
Introduction: A series of Forensic odontological studies on lip patterns form an important weapon for personal identification and may constitute a source of circumstantial evidence. Chieloscopy, i.e., study of lip prints which are unique for every individual and remain unchanged forever can be used successfully in the field of forensic science for personal identification. This study was carried out to determine the common lip pattern, their variations in males and females and their role in the identification of an individual in forensic investigations.
Materials and methods: The study was conducted on 300 North Indians (150 males and 150 females respectively) the age group of 17-60 in the Department of Forensic Medicine, Shri Guru Ram Das Institute of Medical Sciences and Research, Amritsar. A pencil lipstick of the same color and make was applied with a single motion evenly on the lips. Cardboard bearing a 4”x 10” strip of thin bond paper was then pressed to the subject\'s lips, and lip prints were obtained and later studied with the help of a magnifying lens.
Observations and Results: Lip prints were divided into four quadrants and recognized as per Suzuki and Tsuchihashi’ classification. Type I (30.33 %) and Type III (35.41%) were found most prevalent in males and females respectively while Type I’ was least prevalent in males (4.33%) as well as in females (0.41%). The lip patterns remained stable over a period of one year.
Conclusion: Because of unique patterns, the lip prints can be used as an important tool index determination and personal identification in forensic science.
Starvation is a severe deficiency in caloric energy intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage and eventually, death. According to the World Health Organization (WHO), hunger is the single gravest threat to the world\'s public health. The basic cause of starvation is an imbalance between energy intake and energy expenditure. In other words, the body expends more energy than it takes in. This imbalance can arise from one or more medical conditions and/or circumstantial situations. This review attempts to summarize the literature available on the various causes of starvation which may include any disease process or may occur by a voluntary act of shunning of food. The article discusses the body\'s response to starvation, which may be short-term starvation or prolonged starvation. The article also focuses on whether diabetes is a cause or an effect of starvation.
Background: Unicornuate uterus with pregnancy in a rudimentary horn is a rare clinical entity with an incidence of 1 in 76000. Its diagnosis requires a high index of suspicion as it can be very easily missed during a routine ultrasound scan. Management involves laparoscopically or open resection of the rudimentary horn and ipsilateral fallopian tube.
Case report: We present a case of a 28-year old female with pain abdomen and history of intake of abortion pills twice and previous history of normal vaginal delivery. Initial ultrasound scans from remote centers were normal. After a thorough clinical examination, patient was again subjected to a final scan which revealed ectopic pregnancy. A definitive diagnosis of leftrudimentary horn pregnancy was made during laparotomy and resection of a rudimentary horn with ipsilateral salpingooopherectomy was done.
Conclusion: Diagnosis of the rudimentary horn is a challenge. Early diagnosis is necessary to decrease maternal morbidity and mortality.
Aim: To report a rare case of continuation of the peroneal artery as dorsalis pedis artery (DPA) in the foot.
Background: Peripheral arterial system of the lower limb especially the DPA is commonly used to diagnose the peripheral arterial diseases.
Case report: During the routine dissection of a formalized right lower limb of a 52-year-old male cadaver the arterial system of the lower limb was dissected and studied. The popliteal artery (PA) divided into anterior and posterior tibial arteries (PTA) at the lower border of the popliteus muscle. The peroneal artery, branch from the posterior tibial artery was found larger than usual. It ran downward laterally and after piercing the lower part of interosseous membrane continued as dorsalis pedis artery on the dorsum of the foot. The PTA had a normal course and divided distally into medial and lateral plantar arteries. However, the anterior tibial artery (ATA) was hypoplastic and terminated at the level of the talocrural joint. The arterial system of the left lower limb was found to be normal.
Conclusion: The present arterial variation around the ankle is important to the vascular and orthopedic surgeons to prevent the occurrence of any complications during arterial reconstructive surgeries.
Clinical significance: The knowledge of present variation by the vascular surgeons and radiographers help them to diagnose arterial injury for taking vascular graft and embolectomy procedures.
Lipomas are tumors which grow into primary mesenchymal tumors. They develop in areas of abundant adipose tissue. Lipomas represent 4 to 5% of all benign tumors’ in the body. If a Lipoma exceeds at least 10 cm in one dimension or weighs a minimum of 1000 grams, it is considered to be a giant lipoma. We report a case of a 55-year-old female. She was operated for left lipoma breast weighing 12.5 kg. This is probably the largest lipoma of breast reported in the literature. Postoperative recovery of the patient was uneventful. The case prompted this report because of its challenging size, location, diagnosis, and reconstructive solution.
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Gupta T, Sadna G, Aggarwal N. Lesion Sterilization and Tissue Repair—A Recent Novel Approach for the Treatment of Very Uncooperative Pediatric Patients. Curr Trends Diagn Treat 2018; 2 (1):50-53.
Introduction: Root canal complexities of deciduous teeth often makes the treatment difficult and makes the child patient uncooperative and sometimes leads to treatment failure. Therefore the noninvasive approach is needed to obtain good cooperation from child patient.
Aim: This case report aimed to evaluate the use of triple antibiotic paste clinically-a combination of antibacterial drugs, i.e., metronidazole, minocycline, and ciprofloxacin (3Mix), and propylene glycol as pulp medicament on a necrosed primary molar.
Case description: Two children reported with necrosed primary molar and dentoalveolar abscess were treated with lesion sterilization and tissue repair (LSTR) therapy. The triple antibiotic paste was placed in the access cavity and then sealed with glass-ionomer cement. Subjects were asked for recall visits post-treatment, for clinical and radiographic evaluation.
Conclusion: The study revealed that LSTR treatment showed clinical and radiographic positive response on necrosed primary molars in an uncooperative patient.
Introduction: Small group learning (SGL) promotes active involvement of learner in the entire learning cycle, well-defined task orientation with achievable specific aims and objectives in a given time and the reflection based on experience and deep learning. The main aim of this study is to determine the qualitative and quantitative effectiveness of SGL for 6th-semester MBBS students posted in the Department of Otorhinolaryngology for their clinical postings.
Materials and methods: Two sessions of SGL (SGL-1 and SGL-2) were designed and conducted for the students. A pre- and post-test of 15 MCQ questions were used for formative assessment, before and after each SGL session. A feedback questionnaire on five points Likert scale was designed and validated and administered to the students. The data obtained from pre- and post-tests (SGL1 and 2) was statistically analyzed. Both qualitative and quantitative analysis of feedback questionnaire was also done.
Results: There was a marked improvement in the scores in the post-session test both in SGL-1and SGL-2.In SGL-1 pretest 48.86%, students scored marks between the range of 6 to 10 while in the post-test about 89.9% students scored between the range of 11 to 15. In SGL-2, 74.19% students scored marks in the range of 6 to 10 in the pretest while in the posttest 82.25% students scored in the range of 11 to 15. In the feedback questionnaire too, students have supported that SGL had enhanced their learning, communication skills and they all were of the opinion that SGL should be recommended in other departments and should be incorporated in the curriculum.
Conclusion: Small group learning (SGL) is a profoundly effective method of teaching and learning. SGL sessions provide the productive academic environment, strategy for dynamic and collaborative learning during undergraduate training.
MEDICAL ETHICS, LAW AND SOCIETY
Drug side effects become once the drugs enter the market. Such type of side effects also called adverse drug reactions (ADRs). ADRs are a major cause of morbidity and mortality among people and present a major health problem worldwide. Thus, what we need is effective post-marketing safety surveillance (or called as pharmacovigilance). In pharmacovigilance, adverse events are obtained from various sources such as drug manufacturers, healthcare professionals, and patients/people consuming these drugs but this presents a problem of lesser reporting as reporting is voluntary amongst these groups. The solution to this problem is the use of big data analytics. Big data” has become a more and more cited term in health care, for the potential use of the huge amount of data collected from digital medical records or administrative data (e.g., drug prescriptions, hospital dismissal forms, healthcare services, etc. and also as a support for regulatory decisions, pharmacovigilance included. Big data also references artificial intelligence, infrastructure, and services, as well as automated processing operations that facilitate the collection, storage, and analysis of data gathered and being produced in ever-increasing quantities. Big data obtained via social media is analyzed using statistics might have considerable errors and biases for individuals not conforming to group characteristics. Utilization of big data in Pharmacovigilance will bring in the potential to complement traditional spontaneous reporting systems, by allowing an epidemiological approach to determine the incidence of adverse events in the population.
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Arora A, Agnihotri G, Paul S. Biomedical Waste Management—Our Experience at Guru Nanak Dev Hospital Complex, Amritsar, Punjab, India. Curr Trends Diagn Treat 2018; 2 (1):66-69.
Introduction: Biomedical waste (BMW) collection and proper disposal have become a significant concern for both the medical and the general community. Effective management of BMW is not only a legal necessity but also a social responsibility. The present research aims to assess the knowledge, attitude and practice regarding BMW in our institution.
Materials and methods: This study was an observational descriptive hospital-based cross-sectional study, among health care workers in different categories. The study was conducted over a period of two months in a tertiary care hospital and medical college. A structured questionnaire was formulated and validated for the study and responses were solicited from the participating study groups. The study group included the healthcare workers who were grouped into four strata/ subgroups as doctors (residents), nursing staff, laboratory technicians and class IV employees.
Results: While the knowledge regarding general biomedical waste practices was acceptable it was surprising to note that a huge majority lacked awareness regarding disposal of expired drugs. The attitude of workforce and practice of biomedical waste management in our institution has the authors feel has improved with time. Total 70% would like to receive training. However, the majority feels that their responsibility towards BMW management is an extra burden. Only 40% are immunized against Hepatitis B and this figure needs a huge improvement.
Conclusion: The study provides insight regarding the ‘functionality’ of biomedical waste management in our institution and provides useful indicators which will make BMW management more effective and efficient. It will also provide effective and efficient adherence to rules advocated by the pollution control board.